CDC and ATSDR Health Message Testing System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0572 Audience Research on Self-Management Education, Phase III	Form and Instruction	Unchanged	Available
Parents are the Key Teen Driving Safety Initiative	Form and Instruction	Unchanged	Available
Testing Business-Case Videos for CDC's Division of Community Health	Form	Unchanged	Available
Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	Form	Unchanged	Available
Spanish Trench Safety CD-ROM	Form	Unchanged	Available
Form 0920-0572 Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	Unchanged	Available
Radiation Emergencies Infographics Focus Groups	Form	Unchanged	Available
Audience Research on Self-Management Education	Form and Instruction	Unchanged	Available
African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	Unchanged	Available
Form 0920-0572 Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	Unchanged	Available
Form 0920-0572 Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Form and Instruction	Unchanged	Available
Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Form and Instruction	Unchanged	Available
Act Against AIDS Campaign	Form and Instruction	Unchanged	Available
0920-0572 Change Request 12 30 2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-01-05	Available
SS-PartB-HMTS .docx	Supporting Statement B	Uploaded 2011-11-09	Available
Att 12 - Public Comment.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 11 - IRB Ruling 060308.doc	Supplementary Document	Uploaded 2011-11-09	Available
Att 10 - Examples-Data Collection Instruments 060308.doc	Supplementary Document	Uploaded 2011-11-09	Available
Att 9-FollowUpQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 8-ActivityTaskQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 7-CoreQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 6-IntroductoryQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 5-MarketResearchExpQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 4-DemographicQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 3 - Hlth Msg Testing System Expedited Review Form.docx	Supplementary Document	Uploaded 2012-01-18	Available
Att 2_60d FRN.pdf	Supplementary Document	Uploaded 2011-11-09	Available
Att 1-AuthLegislation.pdf	Supplementary Document	Uploaded 2011-11-09	Available
SS-Part A HMTS .docx	Supporting Statement A	Uploaded 2011-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214497	CHMC-Testing Educational Campaign Materials with African American and Hispanic Audiences	Other-PDF	New
214010	Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign	Other-WORD	Unchanged
213762	Audience Research on Self-Management Education, Phase III	Form and Instruction	Unchanged
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	Unchanged
212298	Testing Business-Case Videos for CDC's Division of Community Health	Form	Unchanged
211907	Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	Form	Unchanged
211317	Spanish Trench Safety CD-ROM	Form	Unchanged
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	Unchanged
209309	Testing Health Messages in STEADI Oder Adult Fall Pevention Materials Among Caregivers	Instruction	Unchanged
208865	Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing	Other-Word	Unchanged
208746	HMTS Radiation Focus Group and Emergencies Infographics	Other-Word	Unchanged
208617	Radiation Emergencies Infographics Focus Groups	Form	Unchanged
207551	Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers	Other-WORD	Unchanged
207102	Audience Research on Self-Management Education	Form and Instruction	Unchanged
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	Unchanged
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	Unchanged
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Other-Testing document	Unchanged
204153	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Form and Instruction	Unchanged
203482	Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Form and Instruction	Unchanged
201132	Act Against AIDS Campaign	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 201501-0920-003
Status: Historical Active	Previous ICR Reference No: 201111-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 15JW
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/06/2015
	Date Received in OIRA: 01/06/2015
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	02/28/2015	02/28/2015
Responses	55,575	0	55,575
Time Burden (Hours)	7,510	0	7,410
Cost Burden (Dollars)	0	0	0

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Abstract: CDC would like to process a GenIC for information collection scheduled to ocurr in January-February w015 (i.e., before the Extension ICR can be processed). The number of responses available in the current HMTS inventory is sufficient ot process the GenIC, however, the number of burden hours is insufficient. CDC requests a minor adjustment (Increase) in the number of burden hours currently allocated to the HMTS.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 68358	07/26/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 189	09/29/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

IC Title	Form No.	Form Name
Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	none, none, none, none	Screening Instrument ,   Truck Driver Opinion Survey ,   Exit Survey_Spanish ,   Exit Survey_English Translation
Pandemic Influenza Nonpharmaceutical Intervention Message Testing	none, none	Screener ,   Moderator's Guide
CHMC-Testing Educational Campaign Materials with African American and Hispanic Audiences
Act Against AIDS Campaign	none, none, none, none, none, none	Invitation - General Population ,   Screener - MSM ,   Interview - MSM ,   Screener - HIV+ ,   Interview - HIV+ ,   Interview - General Population
Testing Business-Case Videos for CDC's Division of Community Health	none, none, none	Interview Guide for Videos ,   Eligibility Screener for Business people ,   Survey for Video Testing
Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals ,   ATSDR-Message-Testing_Attachment-7_Communitymembers ,   ATSDR-Message-Testing_Attachment-8_Consent-Form ,   ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean ,   ATSDR-Message-Testing_Attachment-5_Consumers
Radiation Emergencies Infographics Focus Groups	None	Screening Instrument-Radiation Emergencies Infographics
HMTS Radiation Focus Group and Emergencies Infographics
Testing Health Messages in STEADI Oder Adult Fall Pevention Materials Among Caregivers	None	Informed Consent
Audience Research on Self-Management Education, Phase III	0920-0572, 0920-0572	Attachment 4 Screener_10282014 ,   Attachment 3 Mod Guide_10282014
Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	none, none	Screener in English and Spanish ,   Dicussion Guide in English and Spanish
African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	none, none, none, none, none, none, none, none, none, none	African American Screener ,   African American Survey ,   Community Health Wave 1 Screener ,   Community Health Wave 2 Screener ,   Community Health Wave 3 Screener ,   Community Health Wave 4 Screener ,   Community Health Wave 1 Survey Screenshots ,   Community Health Wave 2 Survey Screenshots ,   Community Health Wave 3 Survey Screenshots ,   Community Health Wave 4 Survey Screenshots
Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing
Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign
Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers
Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Planes, Trains and Autop Appendix B3 Response Form ,   Testing of Brand Appendix C1-Moderators Guide- Consumers FG ,   Planes, Trains and Auto Appendix B Instructions for Interview ,   Plane, Trains and Auto Appendix B 1 Interview 1 ,   Planes, Trains and Autop Appendix B2 Interview Cards 1 ,   Planes, Trains Auto Appendix B4 Participant Inform ,   Plane, Trains and Auto Appendix 5 Question 1 Rationale ,   Plane, Train Auto Appendix C Handheld Screenshots ,   Testing of brand Appendix A1-Screener-Consumers 010 ,   Testing of brand concepts Appendix A2-Screener-HCP ,   Testing of brand concepts Appendix B1-Consent form ,   Testing of brand concepts Appendix B2-Consent form- ,   Testing of brands Appendix C2-Moderators Guide- HCP triads ,   Testing of brand Appendix D2-NDPP Branding Message Testing Supplement
Parents are the Key Teen Driving Safety Initiative	none, none, none, none, none, none	Pediatrician Screener ,   Parent Message Testing Moderator's Guide ,   Parent Message Testing Moderator's Guide - Spanish ,   Pediatrician Message Testing Moderator's Guide ,   Parent Screener ,   Parent Screener - Spanish
Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	0920-0572, 0920-0572, 0920-0572	Moderators Guide- Engaged Public Triad ,   Moderators Guide- Community Leaders Triad ,   Moderators Guide- General Public FG
Audience Research on Self-Management Education	none, none	Moderator's Guide ,   Screener
Spanish Trench Safety CD-ROM	none, none	Survey - Spanish ,   Recruitment Script

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,575	55,575	0	0	0	0
Annual Time Burden (Hours)	7,510	7,410	0	0	100	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,550,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/06/2015

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